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Management and etiology of the unilateral multicystic dysplastic kidney: a review
David S Hains1, Carlton M Bates, Susan Ingraham
1Department of Pediatrics, Division of Pediatric Nephrology, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
Insights
Unilateral multicystic dysplastic kidney (MCDK) in children is common, often linked to other genitourinary issues. Routine surgical removal is not supported by current literature.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Unilateral multicystic dysplastic kidney (MCDK) is a frequent congenital urinary tract abnormality in children.
- Its pathogenesis involves genetic factors, teratogens, infections, or obstruction.
- Associated genitourinary anomalies occur in 5-43% of cases.
Purpose of the Study:
- To review the current literature on unilateral multicystic dysplastic kidney (MCDK) in children.
- To summarize known involution rates, contralateral kidney compensatory hypertrophy, and renal function.
- To outline recommended monitoring and management strategies for MCDK.
Main Methods:
- Literature review of studies on unilateral multicystic dysplastic kidney (MCDK).
- Analysis of reported data on involution, compensatory hypertrophy, and estimated glomerular filtration rates (GFR).
- Synthesis of recommendations for monitoring and management.
Main Results:
- Involution rates range from 19-73%; compensatory hypertrophy occurs in 24-81% of cases.
- Estimated GFRs are typically within the normal range (86-122 ml/min/1.73 m²).
- Hypertension and malignant transformation risks are not significantly increased compared to the general population.
Conclusions:
- Serial ultrasonography, blood pressure, and creatinine monitoring are recommended.
- Voiding cystourethrogram is advised for urinary tract infections or contralateral kidney abnormalities.
- Routine surgical removal of MCDK is not supported by evidence.
Abstract:
In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5-43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19-73%, compensatory hypertrophy of the contralateral kidney occurs from 24-81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86-122 ml/min per 1.73 m(2) body surface area. Most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm. The risk of hypertension in those with MCDKs does not appear to be greater than that of the general population, and the rates of malignant transformation of MCDK are small, if at all increased, in comparison with those in the general population. If the patient develops a urinary tract infection or has abnormalities of the contralateral kidney, shown on ultrasound, a voiding cystourethrogram is recommended. Finally, the body of literature does not support the routine surgical removal of MCDKs.
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